Bell flap nipple reconstruction--a new wrinkle

Area of Science:

• Plastic Surgery
• Reconstructive Surgery
• Breast Reconstruction

Background:

• Nipple reconstruction is a critical component of breast mound restoration after mastectomy or for congenital breast asymmetry.
• Existing techniques often require multiple stages, skin grafts, or may not achieve optimal projection and pigmentation.

Purpose of the Study:

• To present a single-stage surgical technique for nipple-areolar complex reconstruction.
• To achieve a well-projected, pigmented nipple-areolar complex without the need for skin grafts.

Main Methods:

• A bell-shaped random pattern flap is designed within a circular subcutaneous island flap.
• The bell-shaped flap is sculpted into an inverted box to form the nipple.
• The remaining island flap is shaped into a cone for the areola, with immediate tattooing and optional Montgomery's tubercle creation.

Main Results:

• The technique was successfully applied to six nipples in five patients undergoing reconstruction with musculocutaneous flaps or from breast reductions.
• Satisfactory-to-good aesthetic results were achieved in terms of nipple projection and areolar appearance.
• The method is not recommended for breast mounds reconstructed solely with implants due to variable blood supply.

Conclusions:

• This single-stage technique offers a viable alternative for nipple-areolar complex reconstruction, particularly in patients with adequate subcutaneous blood supply.
• The described method provides good aesthetic outcomes without the morbidity associated with skin grafts.
• Further evaluation may be warranted for specific patient populations, excluding those with implant-based reconstructions.